Your Spine Surgery at HSS: What to Expect

1. The Weeks and Days Before Your Surgery
2. The Morning of Surgery
3. Anesthesia
4. The Operating and Recovery Rooms
5. Recovery in the Hospital

Having spine surgery can be a stressful and emotional time for anyone, but the staff at Hospital for Special Surgery is invested in using a team approach to provide you with the best possible experience. 

The Days and Weeks Before Your Surgery:

When scheduling your procedure with your surgeon, make sure you obtain an estimate of how long you will be in the hospital. Depending on the type of spine surgery, you may be admitted for a number of days. Make sure to plan accordingly, considering work schedules, holidays, and upcoming family plans.

• Clearance: You will be referred by your surgeon to an internist for clearance for surgery, which includes a history and physical exam as well as laboratory tests. If your particular medical condition requires it, other tests might be needed before surgery, such as an EKG or a chest x-ray; on occasion, you might need additional testing such as a cardiac stress test and pulmonary function studies.

• Medications: You may be instructed by your surgeon and/or primary doctor to stop certain medications (such as strong blood thinners like Plavix or Coumadin, as well as birth control pills and fosamax) several days to a week before your surgery, depending on the medication. In addition, you may be instructed to take some of your medications the morning of surgery even though you will not be allowed to eat that morning. It is important for you to bring a list (or a bag of pill bottles) including all your medications to your medical clearance, including vitamins, over-the-counter medications, and supplements (a number of medications and supplements may interact with medications you might receive after surgery).

The day before your scheduled procedure, a nurse from HSS will call you with additional instructions and reminders. You will be told when and where to come the next morning, and you will be reminded not to eat or drink anything after midnight. This does not apply to the medications that you have been instructed to take the morning of surgery with a small sip of water.

The Morning of Surgery

On the morning of your surgery, you will arrive several hours before your procedure is scheduled to begin.

• The “Holding Area”: You will begin your day in a Pre-Surgical “Holding Area”, where dedicated staff will help prepare you for surgery. A locker will be provided for your belongings, but please leave any valuables at home. This includes all jewelry, as you will be asked to remove it before entering the operating room. You will be asked to change into a hospital gown, and will be assigned a bed in the Holding Area. One member of your family can be with you during this time. A nurse will start an intravenous line to give you fluids, and if you are a woman of child-bearing age, you will be asked to provide a urine specimen for a pregnancy test.  

• Preoperative Exam: A physician’s assistant will take your history and perform a physical exam. The main purpose of this examination is to see if anything has changed since you last saw your medical or surgical physicians. You will be asked to confirm what type of surgery you are having and will be asked to sign consent for that surgery if you have not already done so. Your surgeon or one of his or her assisting physicians will come to speak to you and to sign your surgical site. This is simply a safeguard to confirm where on your body the surgery will be performed. At this time, you will also meet your anesthesiologist, who will discuss what type of anesthesia you will receive.

Anesthesia

Your anesthesiologist will be a Board-Certified or Board Elegible physician who is highly specialized in caring for patients having spine surgery. Having previously reviewed your chart, laboratory results, and other studies, your anesthesiologist will already know much about you. However, he or she will have a detailed conversation with you to clarify any issues and address any concerns you, or they, may have. Your anesthesiologist will also explain the type of anesthesia you will receive, including any special monitoring or necessary care, and discuss post-operative recovery and pain management. Earlier consultation with our Anesthesia Department can easily be arranged by your surgeon or at your request.

Essentially all patients undergoing spine surgery at Hospital for Special Surgery will receive general anesthesia, which involves being put to sleep with medications that are given to you through your intravenous line.  However, the types of medications your anesthesiologist administers during your surgical anesthesia will be specifically suited for spine surgery and compatible with intra-operative neurological spinal cord monitoring. Oftentimes, the choice of medication given during general anesthesia may impact your recovery and pain management after the surgery. Some of the things your anesthesiologist will consider include the length of surgery, any pain medications you may have been previously taking, and any side effects you have had from previous general anesthetics.

The Operating and Recovery Rooms

• Surgery/Anesthesia: After your consultation with the anesthesiologist, you will be taken to the operating room by a nurse. Once there, your anesthesiologist will measure your blood pressure and heart rate and will begin giving you sedative medication. Soon after initiation of general anesthesia, your anesthesiologist will insert a breathing tube which is necessary and essential for your safety during surgery. In certain instances, your anesthesiologist may decide to insert the breathing tube under sedation in order to ensure that you are breathing well and/or to minimize stress on your spine. The surgery will begin once you are completely asleep.

  Typically, the breathing tube is removed at the end of surgery; however, following longer or more involved spine surgery, your anesthesiologist may decide to leave the breathing tube in place for several hours after the surgery. During this time, your body has time to recover from the anesthesia as well as the surgery and other physiologic changes that may have occurred. If this is the case, you will be closely monitored in the recovery room and kept comfortable by appropriate sedation. With some of the more involved spine surgeries your surgeon and anesthesiologist may perform a “wake up test.” This is usually performed by having you follow a simple command, such as “wiggling your toes,” or “moving your feet” as the anesthesia is wearing off. It is not difficult or uncomfortable, but it is something you may notice.

• Recovery: After the surgery, you will wake up in the operating room or recovery room, depending on your sensitivity to the anesthesia. Your initial recovery from the surgery and anesthesia will be in our recovery room, also called the post-anesthesia care unit (PACU). In our PACU there will be an attending anesthesiologist, 24 hours a day, who will closely follow your recovery and post-operative care. You will also have a dedicated nurse caring for you. Several hours after surgery, as you fully wake up, you will be seen by your surgeon and your family members will be allowed to visit. Later in the day, you will be moved to your in-hospital room. Depending on your medical history and the extent of the spine surgery, your anesthesiologist may have you spend the first night in the PACU where there is continual monitoring of your vital signs and you receive the direct care of the PACU anesthesiologist and PACU nurses. 

Recovery in the Hospital

There will be some level of pain following all orthopedic surgeries. The Anesthesia Department works closely with patients and uses a multidisciplinary approach to aggressively manage post operative pain. This includes a variety of different pain medications, physical therapy, and possibly epidural or spinal medications. With the exception of some of the less extensive disk surgeries, your orthopedic spine surgeon will request the consult of our Department’s Acute Pain Service (APS). The APS is a specialized team consisting of an anesthesiologist, a nurse trained in pain management, and a pharmacist. A combination of different pain treatments are incorporated, depending on the type of discomfort you experience as well as the side effects to which you may be sensitive. The APS provides most patients with a “patient controlled analgesia” device (PCA). This is an electronic device that is programmed by the APS and allows you to immediately and safely administer pain medicine as you feel necessary. The APS Team will visit you every day. Our Department also has a Pain Medicine Service, comprised of anesthesiologists specifically trained in the care of patients on long term or complex pain therapies. Our dedicated pain service teams remain in the hospital and are available to you 24 hours a day. The Recuperative Pain Medicine Service (RPM) will ensure that a comprehensive and patient-specific discharge plan (including pain management) is in place for each patient, both during their stay at HSS and when they leave the hospital.

We know your experience with us will be beneficial and will ultimately result in a better quality of life for you and your loved ones. If you have any questions regarding your perioperative anesthetic care, please contact the Anesthesia Department at (212) 606.1206.

posted 3/7/2006